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Proposed molecular mechanisms of the bidirectional relationship of diabetes and PDAC Although the association between diabetes and pancreatic cancer is emphasized by the high diabetes prevalence among PDAC patients over other cancers and noncancer controls ( In the context of diabetes as a risk factor for PDAC, proposed mechanisms broadly centralize around excessive lipid availability, activation of signaling molecules, and the dysregulation of glucose and insulin that helps promote PDAC ( Obesity is the leading risk factor for T2D and is a complex modulator of PDAC development as the pathophysiological features are a combination of excess lipids ( Figure 3 ) ( Figure 3 ) ( Figure 3 ) ( Figure 3 Hyperglycemia, a condition defined by high levels of glucose in the blood is highly associated with T2D ( Figure 3 ) ( Figure 3 ) ( Figure 3 ) ( Figure 3 ) ( While the mechanistic understanding of diabetes as a risk factor for PDAC has been reinforced by association studies and PDAC initiation models ( Mechanisms underlying PDAC-associated diabetes centre around inflammation and -cell dysfunction ( Figure 3 ) ( Figure 3 ) ( Figure 3 )